Descriptions of Barriers to Self-Care by Persons with Comorbid Chronic Diseases

TLDR

Chronic medical conditions frequently co‑occur as comorbidities, and effective management relies on adequate self‑care, yet little is known about how patients with multiple chronic diseases approach self‑care. The study aimed to identify perceived barriers to self‑care among patients with comorbid chronic diseases. The authors conducted semistructured interviews with 16 adults from four urban family practices, using free‑listing to elicit and analyze barriers to self‑care. Participants reported a broad array of barriers—physical limitations, knowledge gaps, financial constraints, logistical hurdles, need for support, cross‑condition interactions, medication issues, and dominance of one condition—many of which were directly linked to comorbidity, indicating that self‑management interventions must address both disease interactions and individual care skills.

Abstract

<b>BACKGROUND</b> Chronic medical conditions often occur in combination, as comorbidities, rather than as isolated conditions. Successful management of chronic conditions depends on adequate self-care. However, little is known about the self-care strategies of patients with comorbid chronic conditions. <b>OBJECTIVE</b> Our objective was to identify perceived barriers to self-care among patients with comorbid chronic diseases. <b>METHODS</b> We conducted semistructured personal interviews with 16 adults from 4 urban family practices in the CaReNet practice-based research network who self-reported the presence of 2 or more common chronic medical conditions. Using a free-listing technique, participants were asked, “Please list everything you can think of that affects your ability to care for your medical conditions.” Responses were analyzed for potential barriers to self-care. <b>RESULTS</b> Participants’ responses revealed barriers to self-care, including physical limitations, lack of knowledge, financial constraints, logistics of obtaining care, a need for social and emotional support, aggravation of one condition by symptoms of or treatment of another, multiple problems with medications, and overwhelming effects of dominant individual conditions. Many of these barriers were directly related to having comorbidities. <b>CONCLUSIONS</b> Persons with comorbid chronic diseases experience a wide range of barriers to self-care, including several that are specifically related to having multiple medical conditions. Self-management interventions may need to address interactions between chronic conditions as well as skills necessary to care for individual diseases.